A Mentally Ill Inmate Slips Through the CracksInto the Path of a Subway Train

On the evening of October 6, 2003, George Nathaniel Atkinson, 35, walked his fiancée, Kia Gayles, to the Archer Avenue/Parsons subway station, at the very end of the E, J, and Z lines in deep eastern Queens. Then he leapt in front of her train. He had been released from the Queens County courthouse three days before, after a month in jail psychiatric wards.

The suicide went largely unremarked in the wider world. The city has disavowed any responsibility for his death. But a special report by court-appointed investigators obtained last month by the Voice tells a different story. After settling a drawn-out class action suit one year ago, New York City is under court order to protect mentally ill prisoners. Atkinson was being treated for severe depression, and the people caring for him in jail were obligated to take several steps to smooth his transition into ordinary life and ensure that his treatment continuedsteps that didn't happen, with the worst possible result.

Atkinson, called Nathaniel, Nate, or Nay-Nay by his family, was "a very strong person," says his mother, Deborah Smith. "We all looked at him as a strong individual," says his older brother Claxton, 37. "We would never contemplate him doing anything like this. We just can't believe it."

photo: Shiho Fukada

George Nathaniel Atkinson was arrested after he called a suicide hotline threatening to shoot himself.

The tallest and strongest of his four brothers, Atkinson had served in the army and last worked at a Radio Shack. He loved baking pies and cakes for family gatherings, and had dreams of attending culinary school like Claxton. Recently, he had been reading the Koran with thoughts of becoming a practicing Muslim like his closest brother, Andrew Smith. Just two years apart, the pair liked to go dancing at the Lenox Lounge or the Tunnel, take in an action movie, play basketball at the 118th Street courts, or dine out at BBQ. "Anytime he needed me, he had my cell number," Andrew says. "He's always been there for me anytime I needed help." To his family's knowledge, Atkinson had never had any psychological problems, though he was upset at times in the last year about trouble finding work. "He was outgoing, giving," says Andrew Smith. "He always helped people. He was joyful."

Nevertheless, according to the investigators' report, on August 31, Atkinson called a suicide hotline. He stayed on the line for over 90 minutes, saying he was suicidal and had access to a gun. The hotline staffers sent the police, who arrested him for possession of his would-be suicide weaponstandard procedure for emotionally disturbed people when a gun is present, according to Mary Beth Anderson, director of the New York Legal Aid Society's Mental Illness and Chemical Addiction Project. "I don't think they should do that, but obviously it happens," she says.

Atkinson was taken first to the emergency room of Queens Hospital Center in Jamaica, and then to the Kings County Hospital Prison Ward in Brooklyn. There, he was diagnosed with major depression made worse by cocaine and marijuana, saw a psychotherapist, and got prescriptions for the antidepressant Zoloft and the mood stabilizer Depakote. While at Kings County he was in touch with his family, who were trying to raise bail. "He called me and said he wanted to get out," says Andrew. "He sounded stressed. He said he didn't want to take the medication, that it made him tired, like a zombie."

After 18 days he was transferred from Brooklyn to the Rikers Island mental health center, where he was placed on suicide watch for four days and seen by psychologists and his Legal Aid attorney. On September 28, Atkinson called from jail to wish Claxton a happy birthday.

It was Heather Barr, a lawyer at the nonprofit Urban Justice Center, who first requested an investigation into Atkinson's death. In 1999, fresh out of law school, Barr filed Brad H. v. Giuliani along with New York Lawyers for the Public Interest. The class action suit challenged the city's practice of releasing mentally ill peopleoften delusional, homeless, and without their medicationsfrom Rikers Island to Queens Plaza between 2 and 6 a.m. with $1.50 in cash and a two-fare Metrocard. (This remains the policy for the general jail population.) The suit sought a "discharge planning" process similar to the one for patients leaving a psychiatric bed at a county hospital. It asked for a caseworker to find them a place in the crowded housing and shelter system, give them prescriptions and a way to fill them, and oversee their transition from jail.

"When I approached Debevoise and Plimpton, a big corporate law firm who ended up taking this on as a pro bono case," says Barr, "I said it would be a really small, tidy lawsuit. We weren't asking for new services to be funded, just for the city to obey the mental hygiene law and the state constitution." Instead, the city fought the suit for four years, with "screaming and shouting and pounding on the tables." At one point in 2001, Barr tried to have Giuliani imprisoned for contempt of court. The 11th-hour State Supreme Court settlement, signed January 8, 2003, spelled out the city's new responsibilities toward the 25,000 "seriously and persistently mentally ill" people released from New York City jails each year.

SPMI inmates, as they are called, are particularly vulnerable to the loss of Medicaid and Supplemental Security Income that comes with being locked up for more than a few days. Inmates are considered to be in the state's care, and in New York it takes at least 45 days after release for the benefits to be reinstated. Discharge planners, who work for the city health department, are now required to visit prisoners receiving mental health care within a week of incarceration and offer their services. The planners must complete new benefit applications for the inmates, screen them for Medicaid eligibility, and make them an initial appointment with a support organization for when they get out. Finally, SPMI class members are supposed to be released in daylight hours, with the medication they need in hand, a place to go, and transportation there. A special Medication Grant Program begun in 1999 provides ex-prisoners with psychiatric meds until their benefits kick in.

Brad H. was named for a man with psychotic and depressive symptoms who has been cycling in and out of Rikers Island, homeless shelters, and state prisons for over 30 years now. The suit "sets a very high standard," says Hank Steadman of the National GAINS Center, which runs jail-diversion programs for the mentally ill. "But the court recognized that it wasn't too high to be realistic."

Steadman describes Brad H. as a groundbreaking attempt to address jails' new social service role. Just as public emergency rooms have become the expensive front line of care for people without insurance, so U.S. jails, which now book about 11 million people a year, are the catchall for the homeless, the mentally ill, and those with substance-abuse problems. There are now far more mentally ill people in the nation's jails and prisons (200,000) than in state mental hospitals (61,700). With an estimated 3,000 mentally ill inmates on Rikers Island at a given time, 800 in hospital beds and the rest in the general population, the New York City jail is, in effect, the state's largest psychiatric facility, and vying with the Los Angeles County jail for the status of largest inpatient psychiatric facility in the country.

"Because of the failure of community-based mental health care, people who should be getting it are getting jail-based care," says Mary Beth Anderson, whose Mental Illness and Chemical Addiction Project represents many Brad H. class members. "And the corrections environment, needless to say, is not a therapeutic one. This is not just about discharge planningit's a systemwide failure."

Atkinson, of course, was not homeless or schizophrenic, just a man in need of help. He had been jailed once before, briefly, as a young man, and he found the rowdy Rikers Island environment unsettling. "He said, 'It's just crazy here,' " reports Andrew Smith. " 'I'm just falling back. It's a madhouse.' "

At Barr's request, within a week of Atkinson's plunge, the court-appointed Brad H. compliance monitors, attorney Henry Dlugacz and Dr. Erik Roskes, had begun a special report for the New York State Supreme Court. The first response by the city's counsel, Jeffrey Dantowitz, was a letter to Debevoise and Plimpton, dated October 15, protesting the investigation. "We disagree with any suggestion that the Compliance Monitors have a wide mandate to investigate the circumstances of Mr. A's death," Dantowitz wrote, using the moniker Atkinson received in court documents. The letter closed, "The mere fact of Mr. A's death, while tragic, does not alter the scope of the Compliance Monitor's authority as negotiated by the parties and set forth in the Settlement Agreement."

Nevertheless, Dlugacz and Roskes found that they did have jurisdiction to interview Atkinson's medical workers, his Legal Aid attorney, and prison staff. His plight comes through despite the report's dry, neutralized language.

While Atkinson was waiting to go before the grand jury on his weapons charge, the errors piled up. Upon his release from Kings County, his discharge plan was listed as "Rikers Island," meaning that no meaningful planning had taken place. The staff of the Community Referral Unit, the Rikers Island discharge planning office, unaccountably expected Legal Aid to make arrangements for Atkinson's follow-up care, while his Legal Aid attorney believed "it was taken care of." A fax from Legal Aid requesting plans, medications, and a referral letter for aftercare was lost because of a machine that stayed broken for weeks. His Rikers Island discharge planner, interviewed by the compliance monitors, could not remember himshe had a caseload of 200 at the time, about average. Her notes showed that she saw Atkinson and gave him three brochures about his rights under Brad H.

Most puzzlingly, after Atkinson had spent 25 days taking antidepressants, yet another mental health professional saw him and downgraded his diagnosis to "adjustment disorder with depressed mood, polysubstance abuse, and antisocial personality disorder." By her determination, he no longer belonged in the "seriously and persistently mentally ill" class that Brad H. covers. "This finding is difficult for the monitors to understand," reads the report. "Our discussion with the clinician who determined Mr. A to be not SPMI indicated a deficit in her understanding of the SPMI definition. . . . Her understanding of SPMI reflects what we believe to be a common misperception among clinicians."

On Thursday, October 2, Atkinson testified before the grand jury, who declined to indict him, and was released directly from the Queens courthouse sometime between 9 p.m. and midnight. Because of further miscommunication between the Rikers referral unit and Legal Aid, he left without his medications, which were waiting for him in a Manhattan office.

"I was in Muslim service when I got the message that Nate had beat the case at the grand jury," said Andrew Smith. "I saw him that day. I gave him about $30. I didn't ask him about his time in jailI figured he would talk about it in his own time. He was talking about a job opportunity he had heard about from a corrections officer. He was happy to be out. But he didn't seem the same. Mostly, when I talk to my brothers, we'll be buggin' out and laughing, but he was just talking about how 'This isn't working for me. I have to get a job.' And he had lost weight. He was a big dude, and the weight had just disappeared from him." Andrew Smith was the last family member to see Atkinson alive.

Atkinson went to live with his fiancée, Kia, who now uses the name Atkinson, at a cousin's home in Queens. (Kia declined through a relative to talk to the Voice.) He left two messages on his Legal Aid lawyer's cell phone on October 6. By the time she returned the calls, it was too late.

His family is still adjusting to the shock of Nathaniel Atkinson's death. His mother can't speak about him for more than a few minutes without dissolving into tears. "She's devastated," says her husband, Sam McCorvey. "She's just in a daze."

The city's statement to the Voice about Atkinson's death offers more defensiveness than hope. "While the services required by the Settlement Agreement will undoubtedly be helpful to many Class Members, they cannot ensure positive results in all instances," Dantowitz wrote. "Thus, while Mr. A's death is tragic, it is completely unjustified and speculative to blame the city for this unfortunate occurrence. . . . We take the observations and recommendations made in the Special Report very seriously, and DOH is carefully considering what steps may be taken to improve its procedures so it can provide the best possible services to Class Members in the most effective manner. While we have had discussions concerning this Report and the Compliance Monitors' Second Quarterly Report with plaintiff's counsel, those discussions are confidential, and any comment on them would be a serious breach of professional ethics."

Barr is hardly satisfied. "There's virtually nothing nice to say about the city's actions," she says. "It's not at all clear to me how they're going to change to be in compliance." Only a few weeks after the special report, the December 17 quarterly report on Brad H. identified 24 separate problems with discharge planning, including coordination, communication, and even basic understanding of definitions and procedures. For example, one-third of the inmates eligible for discharge help are recorded as refusing care because of "inadequate attempts" by mental health staff members to identify themselves and the services they offer. "A lot of our clients don't understand that discharge planners don't work for corrections," says Anderson. "Or they'll say, 'No, I don't need your help, my lawyer's doing it.' " Just 42 percent of the 5,416 eligible inmates released between June 3 and November 15 received a Medicaid prescreening. And only 4 percent of inmates who did participate in the planning had a scheduled appointment on the day of release.

According to Barr, the plaintiffs are running out of options, short of a contempt motion, to compel the city to follow the agreement. "I spent a lot of time feeling really guilty about Mr. A's deaththinking maybe if we'd paid a little more attention it might not have happened," she says. "I didn't get the sense from the city that they're staying up nights.

"Frankly, I think Mr. A's family should file their own suit against the city," Barr continues. Anderson concurs: "Speaking personally, if this was my family member, I would sue. You have a guy coming into the system who has made, by any standards, a serious suicidal gesturefrom a mental health point of view, guns, ropes, gas, those are the ones you have to take seriously. And to my knowledge really nothing was done for this guy."

Nathaniel Atkinson's family has already spoken to a lawyer about making a case. "I know for a fact that Nay-Nay loved life too much to hurt himself," says his mother. "If they hadn't given my child that medication this never would have happened." Adds his brother Andrew Smith, "I feel that the doctors should do their jobs. If they know that someone's suicidal, that person should be getting medication and attending groups. Before they released him they should have made sure he had everything he needed. You don't throw a baby to the wolveswhy would they drug somebody up and then send them out on the street?"